Global Disparities in Pediatric Radiotherapy Infrastructure and Access: A Scoping Review With a Focused Analysis of Morocco

Radiotherapy (RT) is a crucial component of childhood cancer management; however, its global availability and technological capacity remain highly heterogeneous. Despite increasing international attention to childhood cancer care, comprehensive analyses of pediatric RT infrastructure across different economic settings remain limited. This scoping review aimed to characterize the global landscape of pediatric RT infrastructure, treatment technologies, and operational challenges, while highlighting Morocco as an illustrative low- and middle-income country (LMIC) case study. A systematic search identified 1361 records, of which 41 studies published between 2016 and 2025 were included following PRISMA-ScR methodological guidance. Of these, 51.2% originated from LMICs, whereas only 19.5% were conducted in high-income countries (HIC). Advanced treatment modalities, such as intensity-modulated RT, volumetric modulated arc therapy, and proton therapy, remain largely concentrated in HICs, whereas many LMICs continue to rely on limited infrastructure and constrained technical resources. These structural limitations may contribute to delayed treatment initiation and restricted access to pediatric RT. The Moroccan context illustrates both ongoing national efforts to modernize RT services and the persistent scarcity of pediatric-specific data in the literature. Addressing these disparities will be essential to improving equitable access to pediatric RT worldwide.